07-24-2018 Septic Compliance - Laserfiche WebLink

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��Minnesota Pollution ControlAgency Compliance Inspection Form 520 Lafayette Road North Existin Subsurface Sewa e Treatment S stem SSTS St.Paul,MN 55155-4194 9 g y � � Doc Type:Compliance and Enforcement Inspection results based on Minnesota Pollution Control Agency(MPCA)requirements and For local tracking purposes: attached forms-additional local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner within 15 days. System Status System status on date(mm/dd/yyyy): 7/24/2018 p Compliant-Certificate of Compliance ❑ Noncompliant-Notice of Noncompliance (Valid for 3 years from report date,unless shorter time (See upgrade requirements on page 3) frame outlined by Local Ordinance.) Reason(s)for noncompliance(check all applicable): ❑ Impact on Public Health(Compliance Component#1)-Imminent threat to public health and safety ' ❑ Other Compliance Conditions(Compliance Component#3)-Imminent threat to public health and safety ❑ Tank Integrity(Compliance Component#2)-Failing to protect groundwater ❑ Other Compliance Conditions(Compliance Component#3)-Failing to protect groundwater ❑ Soil Separation(Compliance Component#4)-Failing to protect groundwater ❑ Operating PermiUMonitoring Plan Requirements(Compliance Component#5)-Noncompliant Property Information Parcel ID#or Sec/Twp/Range: Property address: 3010 Somerset Lane Reason for inspection: New System Property owner: Jill&Patrick Butler Owner's phone: or Owner's representative: Representative's phone: Local regulatory authority: City of Orono Regulatory authoriry phone: 952-249-4600 Brief system description: Type I Mound for 5 bedroom home Comments or recommendations: Certification 1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of the future system performance has been nor can be made due to unknown conditions during system construction,possible abuse of the system,inadequate maintenance,or future water usage Inspector name: Roger Peitso Certification number: C6683 Business name: License number: Inspector signature: Phone number: ��'—��g^ ��j Q� Necessary or Locally Required Attachments ❑ Soil Boring Logs ❑ System/As-Built Drawings ❑ Forms Per Local Ordinance ❑ Other Information(list): wq-wwists431c • 6/4/14 • www.pca.stafe.mn.us • Available in alfemative fortnats • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 Page 1 of 3